Parra-Romero Gustavo, Ugalde-Hernández Yair, García-López Rabindranath
Vascular Neurosurgery Department, Hospital de Especialidades del Centro Medico Nacional Siglo XXI. Mexico City, Mexico.
Neurosurgery Department, American British Cowdray (ABC) Medical Center, Mexico City, Mexico.
J Cerebrovasc Endovasc Neurosurg. 2025 Mar;27(1):50-59. doi: 10.7461/jcen.2024.E2023.11.003. Epub 2024 Nov 8.
Complex aneurysms are a therapeutic challenge in contemporary neurosurgery. Several microsurgical and endovascular techniques have been proposed for their treatment. The picket fence clipping technique uses fenestrated clips, that are stacked not to reconstruct the neck of the aneurysm, but to create a duct to normalize the cerebral flow by reconstructing the dome. We present four illustrative cases using the picket fence clipping technique. The aneurysms considered were of different locations (ICA, MCA, AComA), of large or giant size with wide necks, in which clipping attempt with a conventional technique was not possible, so that the use of non-conventional clipping techniques had to be applied with favorable results. In our experience we found this technique useful in large and giant, wide-necked aneurysms by reconstructing the parent vessel according to the concept of the ideal closure line in these previously unreported locations, thereby restoring normal cerebral circulation. The use of non-conventional techniques for clipping complex aneurysms can be used alone or in combination for adequate treatment, preserving cerebral circulation without compromising adequate exclusion of the aneurysm. The Picket fence technique is a feasible clipping technique that can be used as a less morbid option in large and giant aneurysms with wide necks.
复杂动脉瘤是当代神经外科手术中的一项治疗挑战。已经提出了几种显微外科和血管内技术来治疗它们。栅栏夹闭技术使用带窗孔的夹子，这些夹子堆叠起来不是为了重建动脉瘤的颈部，而是为了通过重建瘤顶来创建一个管道以使脑血流正常化。我们展示了使用栅栏夹闭技术的四个典型病例。所考虑的动脉瘤位于不同部位（颈内动脉、大脑中动脉、前交通动脉），大小为大型或巨大型且颈部宽阔，采用传统技术夹闭尝试无法成功，因此不得不应用非传统夹闭技术并取得了良好效果。根据我们的经验，我们发现在这些此前未报道的部位，通过按照理想闭合线的概念重建载瘤血管，该技术对于大型和巨大型、宽颈动脉瘤很有用，从而恢复正常脑循环。使用非传统技术夹闭复杂动脉瘤可单独使用或联合使用，以实现充分治疗，在不影响充分排除动脉瘤的情况下保留脑循环。栅栏技术是一种可行的夹闭技术，可作为颈部宽阔的大型和巨大动脉瘤的一种创伤较小的选择。
